Compression Of Vessels Research Articles

The Nuchal Cord Conundrum: Understanding and Addressing Umbilical Entanglement in the Third Trimester of Pregnancy

Background/Objectives: Better understanding of and addressing umbilical entanglement in the third trimester of pregnancy is necessary to estimate its impact on fetal circulation. An analysis of single physiological pregnancies wrapped with one or two coils of the umbilical cord around the neck makes it possible to understand the severity of the problem and distinguish it from perinatal umbilical strangulation. Methods: In an echocardiographic study performed at 32.1 weeks of pregnancy in fetuses with one and two coils of the umbilical cord around the neck, the pulsatility index (PI) and the Tei index for the left (Tei LV) and right ventricle (Tei RV) of the heart were measured to evaluate cardiac function. Results: The study showed significantly higher Tei RV and Tei LV for fetuses with one (93 cases) and two coils of the umbilical cord around the fetal neck (26 cases) with respect to the control group of fetuses (680 cases) with no umbilical cord around the fetal neck, whereas PI UMBA did not differ significantly. Conclusions: Wrapping of the umbilical cord around the fetal neck may affect the study of the fetal heart without any mechanically induced compression of the umbilical vessels in normal pregnancy.

Primary hemifacial spasm: anatomical insights.

Primary Hemifacial Spasm (pHFS) is a disorder caused by compression of vessels on the root of the facial nerve. There has been conflicting evidence regarding the side of the face that is more frequently affected. Moreover, it has been found in several studies that women are afflicted by approximately twice as many as men. We reviewed the literature to explain HFS tendencies from an anatomical aspect. We wanted to see whether there are anatomical variations that can increase the risk of developing HFS or underlie its tendency to a specific gender and side of the face. A PubMed search was done for the articles on "Hemifacial Spasm" published in English literature, and we selected the articles regarding the significant anatomical differences in HFS patients. AICA proximal branching pattern, highly originated PICA, VA dominancy, and VA deviation are among the predisposing anatomical variances. Overall, both sides of the face are equally affected in HFS. However, there are side preferences based on the causative vessels, which may be due to differences in the anatomical features of the left and right side vessels. Various anatomical variations regarding posterior circulation can increase the risk of HFS. Recent evidence suggests whether there is no side dominance or a tendency exists toward the left side. There is no comprehensive explanation for precise reasons underlying the tendency of HFS to affect women. Evidence regarding anatomical variations of the posterior circulation comparing men and women with HFS is scarce, and further studies are required.

Sarcoidosis-associated pulmonary hypertension due to pulmonary arteries stenosis – a case report

BackgroundSarcoidosis-associated pulmonary hypertension (SAPH) is listed in Group 5 of the clinical classification of pulmonary hypertension, due to its complex and multifactorial pathophysiology. The most common cause of SAPH development is advanced lung fibrosis with the associated destruction of the vascular bed, and/or alveolar hypoxia. However, a substantial proportion of SAPH patients (up to 30%) do not have significant fibrosis on chest imaging. In such cases, the development of pulmonary hypertension may be due to the lesions directly affecting the pulmonary vasculature, such as granulomatous angiitis, pulmonary veno-occlusive disease, chronic thromboembolism or external compression of vessels by enlarged lymph nodes. Based on the case of a 69-year-old female who developed SAPH due to pulmonary arteries stenosis, diagnostic difficulties and therapeutic management are discussed.Case presentationThe patient, non-smoking female, diagnosed with stage II sarcoidosis twelve years earlier, presented with progressive dyspnoea on exertion, dry cough, minor haemoptysis and increasing oedema of the lower limbs. Computed tomography pulmonary angiography (CTPA) showed complete occlusion of the right upper lobe artery and narrowing of the left lower lobe artery, with post-stenotic dilatation of the arteries of the basal segments. The vascular pathology was caused by adjacent, enlarged lymph nodes with calcifications and fibrotic tissue surrounding the vessels. Pulmonary artery thrombi were not found. The patient was treated with systemic corticosteroid therapy and subsequently with balloon pulmonary angioplasty. Partial improvement in clinical status and hemodynamic parameters has been achieved.ConclusionsAn appropriate screening strategy is required for early detection of pulmonary hypertension in sarcoidosis patients. Once SAPH diagnosis is confirmed, it is crucial to determine the appropriate phenotype of pulmonary hypertension and provide the most effective treatment plan. Although determining SAPH phenotype is challenging, one should remember about the possibility of pulmonary arteries occlusion.

The pectus care guidelines: best practice consensus guidelines from the joint specialist societies SCTS/MF/CWIG/BOA/BAPS for the treatment of patients with pectus abnormalities.

Pectus defects are a group of congenital conditions found in approximately 1 in 250 people, where the sternum is depressed back towards the spine (excavatum), protrudes forwards (carinatum) or more rarely is a mixture of both (arcuatum or mixed defects). For the majority of patients, it is well tolerated, but some patients are affected psychologically, physiologically or both. The deformity becomes apparent at a young age due to the growth of the ribs and the cartilage that links them to the sternum. The majority of defects are mild and are well tolerated, i.e. they do not affect activity and do not cause psychological harm. However, some young people develop lower self-esteem and depression, causing them to withdraw from activities (such as swimming, dancing) and from interactions that might 'expose' them (such as sleepovers, dating, going to the beach and wearing fashionable clothes). This psychological harm occurs at a crucial time during their physical and social development. A small number of patients have more extreme depression of their sternum that impedes their physiological reserve, which can occur when engaging in strenuous exercise (such as running) but can also limit moderate activity such as walking and climbing stairs. The effects can be so extreme that symptoms occur at rest or cause life-threatening compression of the major blood vessels and organs. The group of patients with physiological impairment usually also suffer from low self-esteem and depression. This paper summarizes the current evidence for the different treatment strategies for this condition, including supportive care, psychological support and non-surgical techniques including bracing and vacuum bell therapy. We also consider surgical techniques including the Ravitch procedure, the Nuss procedure (minimally invasive repair of pectus excavatum), pectus implants and other rare procedures such as Pectus Up. For the majority of patients, supportive care is sufficient, but for a minority, a combination of the other techniques may be considered. This paper also outlines best practice guidance for the delivery of such therapies, including standardized assessment, consent to treatment, audit, quality assurance and long-term support. All the interventions have risks and benefits that the patient, parents and clinicians need to carefully consider and discuss when deciding on the most appropriate course. We hope this evidence review of 'Best Practice for Pectus' will make a significant contribution to those considerations and help all involved, from patients to national policy makers, to deliver the best possible care.

New Insights into Cervicofacial Vascular Anomalies.

Congenital cervicofacial vascular anomalies are extremely rare and present many difficulties in diagnosis and treatment requiring a multidisciplinary approach. Firstly, there is little consensus on this subject among head and neck specialists. There are two main types of vascular anomalies: vascular tumors and vascular malformations. Vascular malformations are also divided into malformations with slow blood flow (veins, lymphatics, capillaries or combined) and malformations with a fast blood flow (arteriovenous malformations and fistula). Vascular tumors like hemangiomas are known for their spontaneous involution with aging, while vascular malformations grow in dimensions with age. It is very important to choose the correct differential diagnosis between cervicofacial hemangiomas and vascular malformations for proper therapy management. Anamnesis and clinical exams help in raising suspicions about the real nature of a cervico-vascular anomaly. Furthermore, imaging brings in-depth details of the anomaly, ranging from ultrasound and contrast CT to MRI scanning and minimally invasive angiography. Angiography with selective embolization is rarely a curative procedure for arteriovenous malformations, being more suitable as a preliminary step before attempted surgical removal. Surgery is clearly necessary when there are aesthetic and functional deficits. Slow-flow vascular malformations present a reduced morbidity, and in cases without involution, the surgical ablation is reserved for the cases with aesthetic dysfunctions or psychological trauma. Lymphatic malformations must undergo surgical ablation when they are associated with mass effects and compression of great vessels or aerial viscera. The prognosis after surgical removal is good, with a low rate of recurrence or morbidity. Fast-flow vascular malformations require a combined approach, with embolization and excision in the next 48 h for safety reasons. Removal may be followed by reconstructive surgery depending on the location and dimensions of the malformation, with a possible secondary recovery of the normal microscopic vessels. Some of the masses may hinder the normal airflow and swallowing. Pathology is the gold standard for confirming the clinical and imaging diagnosis.

Aneurysmatic Dilation of Autovenous Conduit After Coronary Bypass Graft: Clinical Case

Considering the prevalence of cardiovascular pathology and the increase in coronary interventions, including coronary artery bypass grafting (CABG), therapeutic observation and assessment of results, as well as possible complications in this cohort of patients is an urgent problem in the clinic of internal medicine. Autovenous conduits, namely the great saphenous vein, is one of the most common conduits during coronary artery bypass grafting. The reported incidence of minor dilation of great saphenous vein grafts used for CABG varies up to 14 %, but significant dilation of the aneurysm is rare. When performing coronary angiography or multispiral computed angiography, it is possible to establish the true size of the aneurysm, but the presence of mural thrombi can distort the true picture. Complications may include compression of the native coronary vessels, distal embolization, myocardial ischemia, compression of the right atrium, or fistula formation and rupture into the right atrium. The article discusses a rare clinical case of aneurysmal dilatation of an autovenous conduit up to 7.3 cm after 23 years of coronary artery bypass grafting. Considering that the development of aneurysms and pseudoaneurysms in the field of coronary bypass surgery can occur both early and late, clinical vigilance is necessary throughout the entire period of follow-up and informing the patient. The article discusses diagnostic and treatment algorithms for identifying aneurysms and pseudoaneurysms.

A novel hypothesis on cystic changes in pituitary adenomas and their association with a distinct local blood supply pattern

Pituitary adenoma, a common neuroendocrine tumor, commonly exhibits cystic changes as a distinct feature. Here we introduce and investigate a novel hypothesis suggesting a potential correlation between cystic pituitary adenomas and the unique local blood supply patterns of pituitary adenomas. As the tumor expands, compression of the superior vessels results in reduced blood supply from the superior hypophyseal artery, resulting in uneven distribution of the blood flow. Detailed analysis of clinical and surgical features of pituitary macroadenomas showed that cystic changes predominantly manifest in the upper part of the tumor and are driven by metabolic activity and relatively insufficient blood supply in this region. Supporting evidence from dynamic contrast-enhanced magnetic resonance imaging studies further substantiated this hypothesis. Overall, our findings offer a fresh perspective for early diagnosis and surgical decision-making for pituitary adenomas, contributing valuable information for individualized treatment and an improved prognosis. Despite some potential limitations, this hypothesis provides crucial insights into the understanding and management of pituitary adenomas.

Medial End Clavicular Osteochondroma- An Unusual Case

Abstract Osteochondroma is the most common benign bone tumor, which could present as a sessile or pedunculated type and, in solitary or multiples, hereditary multiple exostoses (a genetic disorder, autosomal dominant inheritance). Clinical presentation is mostly asymptomatic, but if symptomatic, it presents in a wide spectrum, such as compression of adjacent vessels, nerves, deformities, fractures, bursa formation, and malignant transformation. Cancerous transformation is indicated by the thickness of the cartilage cap of >3 cm in children, >2 cm in adults, sudden onset of pain, and sudden/rapid growth of lesion (after growth plate closure). Surgical management is indicated for typical symptomatic lesions, complications, malignant transformation, and cosmetic reasons. The common treatment of choice is the excision of a tumor with a significant free margin.

Case report of mucosal ischemia following left hepatectomy: Unveiling a rare postoperative complication

Introduction: Gastric Mucosal Ischemia (GMI) following left hepatectomy is a rare post operative complication, never described in literature. The presented image illustrates the uncommon postoperative complication of Gastric Mucosal Ischemia (GMI) following Liver Resection (LR). Case presentation: A 60-year-old woman underwent left hepatectomy with lymphadenectomy for intrahepatic cholangiocarcinoma. The patient developed intense abdominal pain in 9th Postoperative Day (POD). The subsequent CT scan described: “a 6 cm biloma, pressing and displacing the antral region of the stomach, air emboli in the short gastric veins, edematous wall thickening of the fundus with regions of reduced or absent mucosal enhancement, highlighted with green arrows”. Following conservative treatment, the patient fully recovered, being discharged on the 28th POD. Conclusion: GMI is an infrequent complication encountered after LR. In this case it is attributed to an exceptional observation: the mechanical effects of the biloma causing compression and displacement of gastric vessels, resulting in compromised blood supply to the gastric mucosa and subsequent ischemia.

A synergistic approach for modulating the tumor microenvironment to enhance nano-immunotherapy in sarcomas

The lack of properly perfused blood vessels within tumors can significantly hinder the distribution of drugs, leading to reduced treatment effectiveness and having a negative impact on the quality of life of patients with cancer. This problem is particularly pronounced in desmoplastic cancers, where interactions between cancer cells, stromal cells, and the fibrotic matrix lead to tumor stiffness and the compression of most blood vessels within the tumor. To address this issue, two mechanotherapy approaches–mechanotherapeutics and ultrasound sonopermeation–have been employed separately to treat vascular abnormalities in tumors and have reached clinical trials. Here, we performed in vivo studies in sarcomas, to explore the conditions under which these two mechanotherapy strategies could be optimally combined to enhance perfusion and the efficacy of nano-immunotherapy. Our findings demonstrate that combination of the anti-histamine drug ketotifen, as a mechanotherapeutic, and sonopermeation effectively alleviates mechanical forces by decreasing 50 % collagen and hyaluronan levels and thus, reshaping the tumor microenvironment. Furthermore, the combined therapy normalizes the tumor vasculature by increasing two-fold the pericytes coverage. This combination not only improves six times tumor perfusion but also enhances drug delivery. As a result, blood vessel functionality is enhanced, leading to increased infiltration by 40 % of immune cells (CD4+ and CD8+ T-cells) and improving the antitumor efficacy of Doxil nanomedicine and anti-PD-1 immunotherapy. In conclusion, our research underscores the unique and synergistic potential of combining mechanotherapeutics and sonopermeation. Both approaches are undergoing clinical trials to enhance cancer therapy and have the potential to significantly improve nano-immunotherapy in sarcomas.

Localized osteophytic changes in the thoracic vertebra: an osteological and cadaveric study

Vertebral spinal osteophytes remain an urgent problem for clinicians of various specialties due to the fact that they can cause problems with food consumption, breathing, and sometimes cause compression of blood vessels and spinal cord. Clinical presentations encompass pain, often radiating, reduced function, stiffness, tenderness in the joints, limited movement, nerve compression, and bone pressing against tissues. Vertebral osteophytes are frequently observed in cadaveric anatomy and skeletal remains. Many instances go untreated or undetected. Several cross-sectional and prospective studies have been conducted and published concerning the cervical and lumbar spine. The current study was carried out to observe the incidence of osteophytes in the thoracic vertebrae and to document their frequency of distribution and prevalence. To study the frequency of distribution of thoracic osteophytes was reviewed in 25 cadavers (over a period of 5 years) & 188 dry thoracic vertebras (T1-T12) of south Indian population of unknown age & sex at the Department of Anatomy, MVJ MC& RH, Bangalore. The study meticulously enumerates the positions of osteophytes across different thoracic levels, aiming to investigate and understand their recurrence patterns. Incidence was expressed in terms of frequency and percentage. Incidence of osteophytes was documented in 6 cadavers and 33 dry bones which accounts for 24 % and 17.6 % respectively. Out of these, majority of them were recognized on to right side than on left side of the vertebras. The frequency of osteophytes was most commonly seen at mid thoracic level (T4-T8) followed by T9, T10 and T2. The data we received allow us to form an idea not only about the prevalence of vertebral spinal osteophytes in general, but also about the specific features of their location. Knowledge regarding the thoracic osteophytes is further required for detailed study along with dry bones. A comparative analysis of the prevalence of vertebral spinal osteophytes among people of different specialties, different ethnicities and age groups is important in further research, which will complement the obtained results.

Pediatric scurvy case report: a novel presentation with deep vein thrombosis secondary to large bilateral spontaneous iliac subperiosteal hematomas

BackgroundScurvy is an uncommon disease in developed countries caused by deficiency of vitamin C. We present a case of scurvy in a 14-year-old male with autism with both novel presentation and imaging findings. This case had the novel presentation of lower limb deep vein thrombosis (DVT) secondary to compression of the external iliac vein from large bilateral iliac wing subperiosteal hematomas. Subperiosteal hematoma is a well-recognised feature of scurvy but large and bilateral pelvic subperiosteal hematoma causing DVT has not previously been described.Case presentationA 14 year old Caucasian male with background of autism and severe dietary restriction presented with lower limb swelling and immobility. He was diagnosed with lower limb DVT. Further investigation revealed an iron deficiency anaemia, and he was found on MRI to have large bilateral subperiosteal iliac hematomata causing compression of the iliac vessels. He improved following treatment with vitamin C replacement and follow-up imaging demonstrated resolution of the DVT and hematoma.ConclusionDVT is rare in children and when diagnosed should prompt investigation as to the underlying cause. This case demonstrates an unusual cause of DVT and as an unusual presentation of paediatric scurvy.

Effect of vessel compression on blood flow in microvascular networks and its implications for tumour tissue hypoxia

The tumour microenvironment is abnormal and one of its consequences is that blood vessels are compressed. Vessel compression correlates with reduced survival rates, while decompression of vessels improves tissue oxygenation as well as increases survival rates. Vessel compression contributes, at a single vascular bifurcation, to the increase of heterogeneity of red blood cell (RBC) transport. However, the effect that vessel compression has at a network level is unknown. This work numerically investigates the effect of vessel compression on RBC transport in microvascular networks. The key findings are that vessel compression both reduces the average haematocrit, and increases haematocrit heterogeneity, in vessels in the network. The mechanisms for these changes in haematocrit distribution are unravelled, and a parameter sweep shows that networks with lower inlet haematocrits are more susceptible to haemodilution from vessel compression over a wide range of compressed fraction of a network. These findings provide a theoretical underpinning for the link between vessel compression and tumour tissue hypoxia.

Contemporary outcomes of surgical decompression for functional popliteal entrapment syndrome

BackgroundFunctional popliteal entrapment syndrome (FPES) is an under-recognized source of leg pain caused by dynamic compression of the popliteal vessels by surrounding musculature in the absence of anatomic abnormality. Late recognition and difficulty capturing this entity across imaging modalities can lead to significant morbidity in an often young and active patient population. Surgical outcomes and optimal diagnostic strategies remain uncertain. MethodsWe performed a retrospective cohort study of all patients undergoing surgical decompression for FPES at an academic medical center between 2018 and 2022. Preoperative symptoms, patient characteristics, imaging, operative details, and follow-up were captured. The primary outcome was symptomatic improvement at last clinic visit. Secondary outcomes included symptomatic improvement at 6 months and postoperative complications. ResultsA total of 24 extremities (16 patients) were included. The mean ± standard deviation age was 23.3 ± 6.4 years and 75.0% of patients were female. The median symptom duration before decompression was 27 months (interquartile range, 10.7-74.6 months). Preoperative symptom severity in the affected extremity was as follows: 33.3% limited from peak exercise, 25% unable to exercise, and 41.7% with debilitating symptoms that affected activities of daily living. Preoperative imaging with provocative maneuvers included duplex ultrasound (87.5%), magnetic resonance angiography (100%), and digital subtraction angiography (100%). Using digital subtraction angiography as the gold standard, the sensitivity for detection of FPES was 85.7% for duplex examination and 58.3% for magnetic resonance angiography. The median follow-up was 451 days (interquartile range, 281-635 days). Most patients demonstrated durable improvement in the affected extremity, with 29.2% realizing complete resolution of symptoms and 37.5% reporting symptomatic improvement at last clinic visit for a total of 66.7%; 20.8% had initial improvement, but developed recurrent symptoms and were found to have elevated compartment pressures consistent with chronic exertional compartment syndrome and were treated with formal fasciotomy. Repeat decompression was required in one extremity (4.2%) owing to recurrent symptoms. Two patients (8.3%) had minimal or no improvement in their affected extremity and workup for the cause of continued discomfort was ongoing. ConclusionsDelays in diagnosis of FPES are common. Provocative maneuvers until replication of symptoms across multiple imaging modalities may be necessary to reliably identify the disease process. Surgical decompression improved or completely resolved symptoms in two-thirds of extremities. Treating physicians should maintain suspicion for comorbid chronic exertional compartment syndrome, especially if symptoms recur or persist after decompression.

Indocyanine green is an integral part of breast reconstructive surgery using perforator flaps

The use of allotransplants for breast reconstruction in surgical stage of the the breast cancer treatment requires tissue perfusion control. The aim of the study was to analyze the effectiveness of using indocyanine green as a drug for determining the perfusion of perforant flaps in breast reconstructive surgery. A retrospective series of observations of 27 breast reconstructions using autologous transplants is presented: 19 reconstructions with DIEP-flap, 2 with SIEA-flap, 5 with TD-flap; 1 with thoracoepigastric flap. Intraoperative fluorescence angiography was performed using a Stryker device (5900 Optical Court, USA). The intensity of the flap fluorescence was recorded after intravenous bolus injection of 7.5 mg indocyanine green. The optimal time interval from the moment of drug administration to indicative visualization of flap perfusion was 55-60 seconds. In all patients, the area of insufficient blood flow was excised within intensively blood-supplied tissues, according to mapping data with the indocyanine green. With free transplant of flaps postoperative complications during follow-up were recorded in 1 (4.8%) case (marginal necrosis), which is associated with insufficient compression of auxiliary vessels (violation of the dominant vessel contrast technique). With non-free transplant of flaps no complications were detected in the postoperative period. Indocyanine green allows to prevent necrotic changes and reduce the rehabilitation period. The optimal time for the indicative visualization of flap perfusion was 55-60 seconds. The use of indocyanine green in free transplant of flaps ensured a postoperative period without complications in 20 (95.2%) cases, in non-free flap transplantation - in 6 (100%) cases.

Microvascular Decompression for Hemifacial Spasm without the Use of Neuromonitoring and Fix Retraction: A Single-Center Experience.

To evaluate outcome of patients with hemifacial spasm surgically treated by microvascular decompression without the use of neuromonitoring and fix retraction. Of the 78 patients with hemifacial spasm operated by the senior author of this study between 2016 and 2020, 60 patients who were followed up were included and retrospectively investigated. The female:male ratio was 32:28, and the mean age was 42.5 ± 11.5 years (range 23?71 years). All the patients were operated via the lateral retrosigmoid suboccipital infrafloccular approach, and no permanent retractor was employed during the procedures. Additionally, intraoperative neuromonitoring was not performed for any of the patients. Single vessel compression was observed in 77% of the patients, whereas 16% and 6% experienced compression in two and three vessels, respectively. Immediate recovery was achieved in 70% of the patients. Half of the remaining 30% fully recovered within 6 months?2 years. Furthermore, the complaints of 5% of the patients were alleviated, whereas no improvement was observed in 10% of the patients. One patient developed a recurrence. Microvascular decompression is a highly effective method for the treatment of hemifacial spasm. In this study, we did not resort to intraoperative neuromonitoring and observed that our postoperative complication rates were consistent with the existing literature.

Unique Pathologic Findings in the Heart of a Red-Eared Turtle (Trachemys Scripta Elegans)

The necropsy of a turtle (Trachemys scripta elegans), which was euthanized after rapid loss of vitality, revealed multiple unique abnormalities in the heart. We found areas of atrophy in the wall of the ventricle. These may be connected with aneurysmata at the same locations. A prominent hypertrophic, disc-like cartilago cordis was present. It may have disturbed the flow of blood leading to local atrophies. Gradually, the excessive size may have impeded the flow of blood by compression of large blood vessels at the heart base resulting in ischemia and acute cell death in the myocardium on one side of the ventricle. In one of the larger blood vessels there was an ulcus covered with a thrombus. Thrombi were found on various places and filled the larger part of the ventricular chamber. It can be assumed that these abnormalities were linked and fatal in the end.

Ultrasound characteristics of abdominal vascular compression syndromes.

Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.

A case of successful fertility of a patient with bilateral varicocele on the background of May–Thurner syndrome by combining transscrotal varicocelectomy with X-ray endovascular correction of iliac vessel compression

Arteriovenous conflicts of the ileocecal segment are a frequent cause of recurrent and bilateral varicocele. Insufficient and untimely diagnosis of varicocele causes in this group of patients leads to multiple repeated surgical interventions due to recurrence. This paper presents a clinical case of successful fertility of a 30-year-old patient with bilateral varicocele and testicular hypotrophy on the background of MeyThurner syndrome by two-stage surgical treatment including transsclerotal ligation of testicular veins, angioplasty and stenting of the left common iliac vein.

Hypoxemia of the lower limbs during robot-assisted radical prostatectomy in Trendelenburg position.

The objective of this study is to assess frequency and risk factors for intraoperative hypoxemia of the lower limbs during robot-assisted radical prostatectomy (RARP). Trendelenburg position during RARP may contribute to hypoxemia and compartment syndrome (CS) of the lower limbs as a major but rare complication. This prospective study included patients undergoing RARP for prostate cancer. Preoperative calculation of the ankle-brachial-index (ABI) was performed. Peripheral oxygen saturation (SpO2) at the toes was routinely measured. Occurrence of SpO2 levels of <90% was defined as hypoxemic events and treated immediately. Blood pressure, intraabdominal pressure, SpO2 of the upper limb and surgery time were monitored in case of hypoxemia. A multivariable logistic regression model was performed with age, BMI, nicotine abuse, MAP, comorbidities as covariates and hypoxemia of the lower limbs as the outcome. A total of 207 patients were included. Among these, 126 patients had ABI measurements with 10.6% having an abnormal ABI value. One, two or at least three events of lower limb hypoxemia occurred intraoperatively in 19.7%, 14.8% and 16.9%, respectively. In 20 events, surgical instruments were affecting vascular perfusion by compression. None of the covariates were statistically significant associated with lower limb hypoxemia. No patient developed a compartment syndrome. Decrease in oxygen saturation of the lower extremities was observed frequently during RARP, without revealing any risk factors for its occurrence. Routine oximetry leads to an early detection of hypoxemia of the lower extremities, giving the anaesthesiologist and surgeon the opportunity to make adequate adjustments (increasing blood pressure and ending iliac vessel compression).